Our allies facing colorectal cancer know they must be their own advocate to ensure the best possible treatment. The same is true for protecting your access to health care–it is vital that you stay informed of changes that can impact your health insurance and cancer treatment and be a strong advocate for your rights. To receive updates on important issues in health policy, sign-up here.
End the screening loophole
One of the important provisions in the Affordable Care Act (ACA) is that both public and private payers must cover colorectal cancer screening with no co-insurance or co-pay, but there is a catch. If a polyp is found during a screening colonoscopy, the Centers for Medicare and Medicaid Services (CMS) now codes it as a diagnostic colonoscopy and applies a 20% co-pay. So, seniors believe they have a no-cost screening method but wake up with a surprise bill after a colonoscopy.
Too many seniors are not having life-saving colorectal cancer screenings because they cannot afford the co-pay if polyps are found. It was never the intent to charge seniors for colorectal cancer screening, and the administration has the authority to fix this problem.
The Colorectal Cancer Alliance urges you to contact the president at https://www.whitehouse.gov/contact/ and encourage that he directs CMS to close the colonoscopy loophole in the 2020 Medicare Physician Fee Schedule final rule. This will enable seniors to get screened for colorectal cancer without fear of getting hit with a bill they can’t afford. Screening saves lives, and the president can help reduce unnecessary cancer deaths by fixing the loophole.
Short-term health insurance: Buyers beware
There is a new type of health insurance flooding the market place with the promise of much lower premiums, but as the saying goes: “If it sounds too good to be true, it is too good to be true.”
So, what are these new plans and what do you need to know before buying one?
After Congress failed to repeal the Affordable Care Act (ACA), the administration used a loophole that allowed the president to issue an executive order authorizing “short-term plans” that do not comply with the coverage requirements in the ACA. At the time, the Colorectal Cancer Alliance opposed this as it will result in higher premiums for people with pre-existing conditions.
While the “short-term” designation comes from the fact that these are supposedly just to cover people between jobs, the plans can provide coverage for up to three years.
The profits from these short-term plans are significantly higher than existing health insurance, so they are aggressively marketed with brokers getting much higher commissions. Anyone shopping for health insurance today will likely get dozens of repeat calls pushing these plans.
So–if the premiums are low, why are these plans so profitable? The reason is they often don’t cover much and, in some cases, are all but worthless.
The main thing you need to look for in these plans are all the very weird exclusions. For example, one plan in Illinois covers a hospital stay, but only if the stay begins on a workday; if the insured gets sick on the weekend, coverage does not apply. Others indicate they cover hospitalization, but in the fine print they only cover the days in the hospital, not any of the procedures performed. So, if you go in for a major procedure, your insurance covers the couple thousand dollars for the hospital nights, but the quarter-million dollar cost for the procedure is out of your pocket. Even the best of these plans usually have low maximums, so after $250,000, the insured is on the hook for everything else.
Because of these weird exclusions, some states do not allow these to be sold, and others, such as New Jersey and Massachusetts, regulate the policies. The bottom line is if you are considering purchasing one of these short-term plans to lower your premium, read absolutely every word in the policy and understand what it means before you sign.
Colorectal Cancer Alliance's Speak Up Speak Out program made possible due to educational funding provided by Genentech.